Mouth care

Mouth care is very important for the unconscious, disable, handicapped people. Is it important because if we don not take care of the mouth properly it will affect the normal living. So, read the slide and learn.

1. Topic Mouth care

2. General objective At the end of the session 45 minutes study of course the learner will be able to- Acquire knowledge and developed skills about mouth care . Specific objectives: At the end of the session the students will be able to- to describe the introduction about mouth care. to define mouth care accurately. to explain the principle of mouth care. to identify the purposes of mouth care. to list the indication of mouth care accurately. to list the complication due to neglected of mouth care. to health education for the patient to reduce dental diseases. to list the equipment of mouth care. to explain the procedure of mouth care perfectly. to describe the nursing care plan for the management of any complication developed by mouth care.

3. Introduction of mouth care: The mouth is important for eating, drinking, speech, communication, taste, breathing & the immune system. Daily oral hygiene is critical oral diseases such as dental decay, gingivitis & periodontitis but also because pathogens responsible for pneumonias can be found in the oral cavity. Inadequate oral care has also been associated with a worsening of systemic health problems such as diabetes, stroke, hypertension & MI. So it's important to keep the oral mucosa & lips clean , soft, moist & intact. Oral hygiene is an integral part of health care can prevent potential infections as well as reduce distress & discomfort. Mouth care is also known as “Oral hygiene”

4. Definition: Oral Hygiene is the practice of keeping the mouth Clean & healthy by Brushing & flossing to prevent tooth decay & gum disease Or Maintaining cleanliness of the oral cavity is known as the oral hygiene Or Oral hygiene is defined as “ the scientific care of the teeth & mouth’’ (Xavier 2000)

5. Aim of mouth care Keep the oral mucosa & lips clean, soft, moist & intact. Remove & prevent the build-up of food debris/ dental plaque without damaging the gingiva. Alleviate pain/ discomfort. Prevent halitosis & freshen the mouth. Maintain oral function Decrease the risk of oral & systemic. Increase general wellbeing .

6. Principles of mouth care 1. Intact mucous membrane serves as the final line of defense of the body against diseases. 2. Pathogen grows well in a warm and moist environment. The greater number of organisms, the greater is the possibility of infection. 3. Pathogenic organisms may be transferred from the sources to a new host by direct or indirect method. 4. The skin that is poorly nourished and dry has less ability to protect and is more vulnerable to injury 5. H2O2 acts as anti infective

7. Cont.… 6. Hygienic practices vary between individuals, between people of Different economic status and different culture 7. Any unfamiliar situation produces anxiety.

8. Purposes of mouth care: 1. To keep the oral mucosa & lips clean, soft, moist & intact 2. To alleviate pain 3. To remove& prevent the buildup of food debris ? Dental plaque without damaging the gingiva 4. To keep the mouth clean and refreshed. 5. To increase general well being.

9. Cont.… 6. To prevent infection and dental caries 7. To prevent infection of salivary gland. 8. To treat a mouth infection. 9. To help maintain, improve patient's appetite. 10. To promote self esteem and comfort.

10. Cont.….. 11.To prevent complications such as stomatitis, glossitis, pyorrhea, profits, halitosis etc. 12.To avoid foul breath and foul odor while talking. 13.To educate the patient and family regarding the importance of oral hygiene.

11. Indications of mouth care: 1. Unconscious patient. 2. Helpless & serious patients 3. Patient with hyper-pyrexia. 4. Patient with NPO (nothing per oral). 5breathers. 6. Patient has local disease of the mouth 7. Patient on oxygen inhalation. 8. Patient on chemotherapy. 9. Malnourished & dehydration, patients

12. Cont.… 7. A patient who is unable to maintain adequate oral hygiene. 8. Patient with hyper-pyrexia. 9. Malnourished and dehydration patient

13. Contraindication of mouth care Oral surgery or trauma may contraindicated tooth brushing

14. Complications 1.Gingivitis : Inflammation of gum.

15. Cont.. Dental caries

16. Cont.. Stomatitis : Inflammation of the mucous membrane of mouth .

17. Cont.. Pyorrhea ( Pus formation in the sockets of the teeth)

18. Cont.. Parotitis ( Inflammation of the parotid gland)

19. Cont.. Glossitis ( Inflammation of the tongue)

20. Cont.. Cracked lips

21. Cont.. Sores Anorexia ( Loss of appetite)

22. Health education for the patient to reduce dental diseases:

23. Cont … 1.Moisten the tooth brush and apply tooth paste. 2.Hold the tooth brush at a 45 degree angel to the teeth. 3.Brush the front and back of all the teeth from the gum line toward. 4.Tongue should be cleaned every morning by a tongue cleanse. 5.Teeth should be cleaned twice daily(morning ,at night). 6.Consult with dentist every 2 month.

24. Advantages Its help prevent oral cancer. Its help prevent gum disease. Its help detect dental problems early. Its help maintain good oral health. save money Pressure breath Whiter teeth

25. Disadvantages Mouthwash can be dangerous for children when ingested . Mouthwash can damage some parts of the mouth, stain and darken teeth and also irritate canker sores .

26. Solutions used for mouth care Normal saline solution : This is a solution of common salt with water, in proportion to 4gm in 500cc of water. This is commonly used in wards. Hydrogen peroxide ( H 2 O 2 ) : Solution is readily available in market as a deodorizing agent, 5 – 20cc can be used for mouth purpose. Potassium permanganate: This is available in crystal form. 4cc of potassium permanganate solution in a glass of water can be used for mouth care. Alternately 1 small crystal can be put in a glass of water. This is a powerful disinfectant and deodorizing agent. Soda-bi-Carb : The solution is made with 4gm of soda bi card powder in pint of water. Thymol solution: One-forth of half tea spoon of thymol is put in 1 cup of water ( 100-150cc of water). It is acts as an antiseptic agent. Lemon juice: 2 tea spoons of lemon juice in a cup of water can be used as an improvised methos for mouth wash. NOTE : Never use Dettol as mouthwash antiseptic .

27. Precautions Special precaution for providing oral care according to life span: Infant: Use a dry gauze to remove accumulated secretions from an infants gums. Use a small, soft brush after first teeth have erupted . Child: Remember that children younger than 30 years may not understand what rinse or spit means. Don’t after them water to rinse with if they are NPO because they will swallow the rinse. Pay special attention to children to ensure removal of food particles from the airway.

28. Cont.. Older adult: Because many older adults wear full or partial dentures be sure dentures are removed & cleaned regularly. Special dentures cleansers are available. Brush the gums or any remaining teeth well. Others: Before offering mouth care must wash hands thoroughly (for conscious patient). Sit the patient fully upright position to prevent aspiration during mouth care (for conscious patient). Avoid oral care with H2O2 if oral thrush or oral lesson present.

29. Procedures of mouth care Equipment's: A tray with cover- Feeding cup Mouth wash solution or toothpaste and toothbrush Jug of water Kidney tray Galli pot with denture socking solution Gauze piece with bowl 1 artery forceps & 1 dressing forceps Boroglycerine 1 small towel & 1 small mackintosh Tongue depressor Mouth gag Disposable gloves

30. Procedures For conscious patients: Collect all equipment's Bring the tray to the bed side. Wash hands & don disposable gloves. Greet the patient & explain the procedure. Maintain Proper privacy. Help the patient to sit up in a comfortable position, if necessary supported by pillows.

31. Cont.. Place the mackintosh & towel under the patients face & chin. Use artery forceps to clean the tongue, roof of the mouth & lips with gauze & fresh water. Take tooth brush & toothpaste & systematically clean the teeth. Begin on the outside of the teeth, brush up & down. Place the kidney tray beside the patients mouth & help the patient to rinse the mouth & gargle the throat with clean water.

32. Cont.. Remove the kidney tray & wipe the patients mouth & lips with the towel. If necessary, apply lubricants to the lips ( to prevent dry & cracking) Mouth should be rinsed after every sweet diet. Make the patient comfortable. Remove all equipment’s from the bed side & replaced in a proper place. Wash hands. Record the procedures & observations in the patients file. Note the conditions of the patients mouth, tongue, lips & gums & report any abnormalities to the nurse incharge .

33. Procedures for unconscious patient Collect all equipment's Bring the tray to the bed side. Wash hands & don disposable gloves. Greet the patient & explain the procedure. Maintain Proper privacy. Place the patient in a side lying position towards the defended side. Place the mackintosh & towel under the patients face & chin.

34. Cont.. Place the kidney tray close to the chin. Use any dentifrice to clean the teeth. Do not pour water in the mouth. Wraps a swab around the forceps covering the lips completely & clean the mouth systematically, clean the mouth in the following water inside checks, gums, teeth, roof of the mouth, lips. Use tongue depressor if needed. Use as many swabs as required till the mouth is clean. When the teeth & tongue are cleaned well, stop the procedure, wipe the lips & face with towel. Apply Boroglycerine on the cracked lips & tongue.

35. Cont.. Remove all equipment’s from the bed side & replaced in a proper place . Make the patient comfortable . Wash hands . Record the procedures & report any abnormal condition to the nurse incharge & physician.

36. Nursing care plan: Nursing Diagnosis Goals Interventions Evaluation Risk of injury due to improper way of mouth care To Prevent injury due to improper way of mouth care Use of soft gauze piece. Gently wipe the mouth to prevent injury. Do not rubbing in the mouth Slowly wipe the mouth and lip. Use moisturizer to prevent dryness Gradually reduce the risk of injury. Risk of difficulty in swallowing To prevent difficulty in swallowing Encourage small & frequent feeding. Render oral care before feeding. Proper positioning while feeding. Instruct the patient not to talk while feeding. Gradually the patient can swallow comfortably.

37. Nursing Diagnosis Goal Interventions Evaluation Risk of oral thrush, gingivitis, glossitis, dental caries etc. To prevent oral thrush, gingivitis, glossitis, dental caries etc. Brush teeth after each meal. Soak dentures overnight in corsodyl. Give antifungal medicines according to doctors order. Early treatment can minimize symptoms & prevent erosion of mucosa & spread in other parts of GI tracts. Gradually decrease risk of oral thrush, gingivitis, glossitis, dental caries etc.

38. Nursing Diagnosis Goals Interventions Evaluation Deficient knowledge about mouth care. Demonstrate knowledge on mouth care Asses the patients knowledge about mouth care. Explain the importance of mouth care to the patient and relatives Explain about complication delay in mouth care. Explain about drug regiment and its side effects. Encourage patient or relatives to maintain cleanliness and hygiene. Precaution should be taken to maintain bleeding e.g. Used soft bristled tooth brush. Gradually demonstrate knowledge about mouth care.

39. Conclusion Mouth care is vital aspect of patient care specially for the seriously ill patient as they usually wholly dependent on others to provide mouth care such as in ICU. Within the ICU setting ventilator associated pneumonia is the predominant nosocomial infection with a mortality rate of between 54% & 71% ( Grap,munro,ashitiani & Bryant,2003). So, if we want to save the life of a patient, mouth care is crying need for them. Let’s keep our patients smiling by improving our care & increasing education regarding mouth care. No matter what your age -5, 25, 65, or 85 years- oral health is vital to your general health & well-being.